[R-G] Iran Fights Scourge of Addiction in Plain View, Stressing Treatment

[Yoshie Furuhashi]

<http://www.nytimes.com/2008/06/27/world/middleeast/27addiction.html>
June 27, 2008
Iran Fights Scourge of Addiction in Plain View, Stressing Treatment
By NAZILA FATHI

TEHRAN — Ali blew out a candle on a small round cake. More than 200
people cheered, celebrating the first anniversary of his becoming
drug-free.

"I was in an awful condition," said Ali, describing 12 years of
addiction to opium and alcohol. "I reached a state that I smashed our
furniture and threw our television out of the window."

Ali, 31, who has a wife and child and identified himself by only his
first name to avoid possible embarrassment to his family, is among
more than 800 addicts struggling to overcome their habits at a free
treatment center in central Tehran.

More than a million Iranians are addicted to some form of opium,
heroin or other opium derivative, according to the government, and
some estimates run as high as 10 million.

In a country where the discussion of some social and cultural issues,
like homosexuality, can be all but taboo, drug addiction has been
widely acknowledged as a serious problem. It is talked about openly in
schools and on television. Posters have encouraged people to think of
addiction as a disease and to seek treatment.

Iran's theocratic government has encouraged and financed a vast
expansion in the number of drug treatment centers to help users
confront their addictions and to combat the spread of H.I.V., the
virus that causes AIDS, through shared needles.

The center in central Tehran, which is called Congress 60 and is run
by a private nonprofit agency, is one of 600 centers that provide drug
treatment across the country with help from government money. An
additional 1,250 centers offer methadone, free needles and other
services for addicts who are not ready to quit, including food and
treatment for H.I.V. and other sexually transmitted infections.

Iran's government, trying to curb addiction's huge social costs, has
been more supportive of drug treatment than any other government in
the Islamic world, according to the United Nations Office on Drugs and
Crime.

It was not always this way. After the 1979 revolution, the government
tried a more traditional approach: arresting drug users and putting
them in jail.

But two decades later, it recognized that this approach had failed. A
sharp increase in the crime rate and the number of people infected
with H.I.V., both directly linked to a surge in narcotics use,
persuaded the government to shift strategies.

"We have realized that an addict is a social reality," said
Muhammad-Reza Jahani, the vice president for the Committee Combating
Drugs, which coordinates the government's efforts to fight drug
addiction and trafficking. "We don't want to fight addicts; we want to
fight addiction. We need to manage addiction."

No one knows for certain just how widespread addiction is. The
official estimate is 1.1 million people, according to Esmail Ahmadi
Moghadam, the leader of the security forces. Mr. Moghadam has banned
the use of any other statistics on addiction, according to the
state-run news agency IRNA.

But some experts put the number much higher. At a conference on
addiction in 2005, Ahmad Kavand, an official in the Interior Ministry,
put the number of addicts at 10 million, or about one in every seven
people in Iran, the semiofficial Fars News Agency reported.

Southern Tehran has neighborhoods where homeless addicts can readily
be found sleeping in parks or openly injecting drugs. The smell of
opium in residential neighborhoods, even in affluent areas, is common.

Opium has deep cultural roots in Iran. It has long been considered an
effective painkiller, and its use is socially acceptable. Many addicts
start by smoking opium occasionally, and move on to heroin and other
opium-based narcotics after becoming dependent.

In many cities, a bride brings the equipment for smoking opium as part
of her dowry. Before the 1979 revolution, the government gave opium to
addicts to enable them to avoid drug dealers.

"Opium in our culture is like Champagne in France," said Dr. Ali
Alavi, with the United Nations Office on Drugs and Crime. "Many use it
for entertainment."

Drug abuse is even more common outside Tehran and other large cities,
particularly in the provinces along the drug-trafficking routes that
run from Iran's long eastern border with Afghanistan, where opium
poppies are grown, to the northwest, where it is transported to Turkey
and Europe.

More than 93 percent of the opium produced for the world's illicit
narcotics markets comes from Afghanistan, according to the United
Nations Office on Drugs and Crime, and Iran is the main trafficking
route for nearly 60 percent of the opium grown in Afghanistan.

With opium production skyrocketing in Afghanistan, some Iranian
officials accuse the American military of ignoring poppy cultivation
in Afghanistan, even though it is a major source of revenue for the
Taliban and Al Qaeda.

"We think the Americans want to keep this source of infection near
us," said Mr. Jahani, the Iranian antidrug official. "Because of the
animosity between Iran and the U.S., this is the best way to keep our
resources and forces occupied."

The government grew so concerned about drug trafficking that it spent
$6 billion in 2006 to build a wall 13 feet high, with barbed wire, and
a trench 13 feet deep and 16 feet wide along a third of Iran's border
with Afghanistan. Iran seizes more illicit opiates than any other
country, the United Nations Office on Drugs and Crime said, and it
burns tons of confiscated drugs in a ceremony every year.

Still, plenty gets through, and drug abuse remains widespread. The
drugs have been getting stronger, too. Four years ago, dealers
introduced a further refinement of heroin known here as crack.
Unrelated to crack cocaine, the drug is mostly smoked, is vastly more
powerful than raw opium and has caught on rapidly.

Four years ago, 54 percent of addicts in Iran used opium, according to
a survey by the Committee Combating Drugs. Only 30 percent of addicts
now use opium, the survey found, with many having switched to crack.

Some people who become addicted to crack are unaware that it is made
from heroin. Samira, 21, who said she had been smoking crack for four
years, dragged herself to the House of Sun, a drug treatment center
for women in Tehran, trying for the seventh time, she said, to find a
way to quit.

She said she started smoking opium when she was 15 to relieve the pain
of a broken leg.

"My sister is married to a drug dealer, and he told me that crack was
not addictive," she said, struggling to keep her eyes open. "I have to
smoke at least every two hours now."

In dealing with opiate addiction, the government has also had to begin
addressing AIDS, which had long been considered a Western problem. The
front line has been prisons, where heroin addiction and needle-sharing
are rampant. After a 25 percent surge in H.I.V. cases, the government
began distributing free needles in prisons in 2000.

The government insists that there are only about 17,000 people with
H.I.V. in Iran, but it has also ordered drug treatment centers not to
disclose how many of their clients have AIDS.

At one Tehran center, Ali Yaghoubi, 47, with hollow cheeks and eyes,
said he became infected with H.I.V. while serving a 25-year prison
sentence for robbery and selling drugs. "We had to share something
called a pump for injecting heroin," he said. "It was a thick needle
hooked up to a pump."

The number of addicts taking methadone has increased to 100,000 from
5,000 in two years, Kamran Bagheri Lankarani, the minister of health,
said in May, according to Iran-e-Pak, a magazine about addiction.

Almost all of the alternative treatment centers are subsidized by the
government, but still have a relatively free hand in choosing their
methods.

"There are so many options that no addict can claim that there is
nowhere to go for help," said Dr. Mohammad-Reza Haddadi, a physician
and researcher at the National Center for Addiction Studies. "It is
much cheaper and healthier for them to go to these centers for
methadone than to drug dealers."